In most areas of modern medical practice a typical physician is likely to prescribe a variety of medications on a daily basis. Unlike many areas of medicine, for example medical imaging, that have incorporated sophisticated computer technology with resulting improvements in patient care, the issuing of prescriptions has remained primarily a manual task. Yet issuing prescriptions is one of the most important and ubiquitous tasks of the physician. It is estimated that over two thirds of all physician-patient encounters culminate with the writing of a prescription.
After obtaining relevant historical information from a patient, performing a physical examination along with appropriate laboratory tests and possibly consulting the patient's medical record, the physician arrives at a diagnosis or at least an evaluation of the patient's condition. Following this process the physician typically selects one or more medications with the goal of treating the patient's condition and/or relieving symptoms. In making the selection, the physician utilizes patient-specific information including past medical history, current condition and concurrent medications, possible contraindications and potential drug interactions. The physician also relies on his or her preferences based on past experience with various medications and also on new information such as that provided by drug industry representatives and recent scientific research.
In addition to choosing the medication, the physician must also select a dosage amount, dosing time, and route of administration. The physician must sign the prescription and provide his/her license number, thereby confirming that the prescription was written by an authorized prescriber. The process of writing prescriptions varies somewhat depending upon the clinical setting. For example, in hospitals an order to administer a drug may be written directly in a patient's chart or entered into a computerized, hospital-based medical order system. The order is transmitted to the hospital pharmacy either directly or by a nurse, and the medication is administered to the patient by a nurse.
Far more typically prescriptions are written in an outpatient setting. The information that the physician must include on the prescription includes patient identification, medication name, dosage amount, timing, total amount of medication to be given to the patient, information regarding refills, physician's signature and license number, date, and possibly brief instructions and/or warnings. Optionally the physician can indicate that a brand name medication is to be dispensed as written, i.e., that the pharmacist should not substitute a generic medication. In the absence of such an indication the pharmacist is free to substitute a generic medication for a branded drug. Prescription information is typically written on a small piece of paper which may be preprinted with the physician's name and/or place of work. The patient presents the written prescription to a pharmacy for fulfillment. The pharmacist then fills the prescription, generating a label listing the name of the drug along with instructions to the patient regarding when to take the medication and how much to take each time.
The writing and transmission of prescriptions in a timely and accurate manner is of the utmost importance. Unfortunately, the system as described above has significant shortcomings. Firstly, it relies upon the handwriting of physicians, which is notoriously poor. If a pharmacist is unable to correctly interpret the medication name, dosage information, etc. written by the physician, there is a chance that the wrong medication will be given to the patient. To prevent such mishaps pharmacists frequently must contact the physician by phone to confirm the necessary information. It has been estimated that as many as ten percent of written prescriptions result in such “callbacks”, representing a waste of physician and pharmacist time and introducing an opportunity for error if the physician cannot accurately recall exactly what he or she originally wrote. Callbacks also result in patient inconvenience and delay in obtaining necessary medication. Another drawback of the current system is the opportunity for fraudulent prescribing. In many health care settings there are few safeguards on the availability of “official-looking” prescription pads, and it is relatively easy for unauthorized persons to obtain them and write prescriptions, as long as these persons are able to learn a physician's license number. Pharmacists typically have no means of verifying that the signature on a prescription indeed belongs to an authorized prescriber. Furthermore, pharmacists have no way of verifying that the prescription information has not been altered, e.g., by changing the number of pills to be dispensed. There exists a need for methods and systems that will reduce or eliminate problems associated with inability to read physician handwriting on prescriptions. There further exists a need to minimize opportunities for fraud associated with prescription filling.
Computer-based systems for entering prescriptions can provide a number of advantages including minimizing problems with physician handwriting and potential fraud. In today's time and cost conscious environment, computer-based prescription and management can also offer significant improvements in efficiency. Furthermore, if connected to databases containing patient records, they can alert the physician if the patient has previously experienced an allergic reaction to a particular medication or has a contraindication to that medication. If connected to databases containing drug information, they can alert the physician to possible drug interactions and contraindications. It is recognized that a significant number of adverse patient experiences result from avoidable medication errors. Accordingly, there exists a need for improved methods and systems for checking that medications are prescribed appropriately.
Despite the advantages mentioned above, there are several barriers to the adoption of computer-based prescription entry. Physicians are highly mobile, often engaged in professional activities at multiple geographically distinct locations. They are frequently involved in patient encounters in sites such as examination rooms, hospital rooms, specialist areas such as imaging suites, etc., where they may not have access to a computer terminal. Small notebook computers, which a physician could transport, would theoretically eliminate the problem of limited access to terminals. However, given that physicians frequently already carry about diagnostic equipment, pocket references, etc., it is unlikely that they would embrace the notion of adding a notebook computer to their burden. Furthermore, such computers must often be plugged into wall jacks in order to electronically transmit information over a computer network. In addition, physicians are increasingly being consulted about patients over telecommunications equipment such as cellular phones and in settings in which use of either a traditional or notebook computer is impractical.
In order for a computer-based system to be widely adopted it must rival the current format of the written prescription in terms of rapidity and ease of use. At present, a physician can write a prescription by hand literally within seconds, at any time or place. Prescriptions are typically written at the termination of a patient encounter. With the increasing pressure on physicians to see more and more patients, it is typical for the end of the encounter to be very rushed, particularly if the physician feels that he or she has fallen behind the planned schedule. Most experienced physicians have long since memorized names, doses, etc., for medications that they prescribe frequently. Physicians will not be willing to adopt a system that requires a time-consuming selection process or that constrains them to enter information other than that necessary for appropriate completion of the prescription. They will not be willing to scroll through long lists of drugs, doses, and formulation options, or to laboriously enter drug names on a miniature keyboard. Thus despite the advantages of computer based prescription entry, it has not been widely adopted, particularly in outpatient settings and independent private practices. There exists a need for a streamlined, user-friendly electronic prescription entry system that will offer convenience that rivals or exceeds the traditional handwritten prescription in terms of ease of use for the prescriber.
Although prescriptions are generally written by physicians and filled by pharmacists, both providers and the patient population rely upon the activities of pharmaceutical manufacturers to ensure that medications will be available for dispensing. In a broader sense, the health care community and the population as a whole rely upon pharmaceutical companies to develop and introduce new and effective medications and to appropriately inform both groups as to the availability and advantages of these new medications. Through scientific publications, advertising both to the medical community and increasingly to the public, and through the distribution of free drug samples to physicians, pharmaceutical companies provide relevant and timely information about their products.
It is common practice for pharmaceutical sales representatives to distribute free drug samples to physicians, who in turn can give them to their patients. Distribution of free samples serves a number of important roles. The presence of these samples alerts the physician to the availability of a new drug, encouraging him to consider whether it might offer an improvement over the treatments he is currently prescribing. Patients can take the drug on a trial basis without needing to purchase it, thus avoiding the possibility that a patient will end up paying for a drug that is not effective for his condition. Physicians can gain experience with the medication, which may lead them to recommend its addition to hospital formularies.
Currently most distribution of free samples is done when a sales representative visits a physician, typically at the location of his practice. The representative gives the physician a certain number of free samples and typically writes down the number of samples of each medication distributed. Much like a physician, sales representatives are highly mobile and rely on the convenience of a traditional pen/pencil based system to record their transactions rather than using a desktop or notebook computer. To work properly, however, the present system requires that the sales representative manually maintains organized, up-to-date records of when and where he distributed sample and what lot numbers he distributed to a particular physician or site. In addition, the current system does not provide any means by which a sales representative can determine how much of the material distributed has been used. Thus physicians may run out of samples before the next time the representative visits. There exists a need for an improved system by which sales representatives and pharmaceutical manufacturers can record and track sample distribution and usage.
To operate effectively in today's competitive marketplace and to respond rapidly to new opportunities and demands, pharmaceutical companies need to be able to track the number of prescriptions written for the medications they produce. Present means to obtain this type of data rely on retrospective surveys and often result in incomplete data available only months after the relevant prescribing activity has taken place. Thus there exists a need for a system whereby pharmaceutical manufacturers can obtain timely information regarding the usage of their products.